Assessment of Cervical spine surgery in ankylosing spondylitis

Abstract

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the axial skeleton, often leading to significant cervical spine involvement. Progressive spinal inflammation can cause pain, stiffness, and ultimately, severe deformities like kyphosis and subluxation, impacting neurological function and quality of life. Surgical intervention in the cervical spine becomes necessary when conservative management fails to alleviate debilitating symptoms or when neurological compromise arises. This abstract summarizes the complexities and considerations involved in cervical spine surgery for AS patients. Cervical spine surgery in AS presents unique challenges due to the altered bony anatomy, frequent osteoporosis, and the presence of syndesmophytes, which make instrumentation technically demanding. Common indications for surgery include intractable pain, progressive neurological deficit, cervicomedullary compression, and severe deformities causing functional limitations. Preoperative planning is crucial and involves detailed radiological assessment with CT and MRI to evaluate bone quality, the extent of spinal involvement, and the presence of any spinal cord compression. Careful patient selection is paramount, considering factors like age, comorbidities, and disease activity. Surgical goals primarily focus on restoring sagittal and coronal balance, decompressing neural structures, and stabilizing the spine. Various surgical techniques are employed, including posterior osteotomies (e.g., Smith-Petersen, pedicle subtraction), anterior cervical discectomy and fusion (ACDF), and combined anterior-posterior approaches. The choice of technique depends on the specific pathology, the degree of deformity, and surgeon experience. Intraoperative neuromonitoring is essential to minimize the risk of iatrogenic neurological injury. Postoperative management involves appropriate pain control, early mobilization, and bracing to promote fusion. Long-term follow-up is necessary to monitor for complications like implant failure, non-union, and infection. While surgical outcomes are generally favorable in terms of pain relief and functional improvement, patients with AS undergoing cervical spine surgery face a higher risk of complications compared to the general population. Further research is needed to refine surgical techniques, optimize patient selection, and improve long-term outcomes in this challenging patient population. This includes exploring minimally invasive approaches and developing strategies to mitigate the risk of complications.